Ok... I'm going to ask a dumb question....

[wifeandmomoftwo]

I'm half way through an LPN program. Our clinicals take place in the med/surg dept of a small local hospital. When we aren't otherwise occupied we are supposed to answer call lights. One of the things that the call lights go off a lot for is the pts needing help to the bathroom. Is there a way to determine how well they can walk before gettting them up out of bed? I ask them. Some of them will tell me they can do it but then they get up they have trouble. I always make them sit on the side of the bed first and stand behind them with my hands on their waist just in case. Nothing bad has ever happened but this is one thing that makes me uneasy. Is there some way to quickly physically assess them without just taking their word? Obviously if they didn't need some assistance they wouldn't hit the call light. Just wondering if there is something else I could do :)

[MattiesMama]

I would be very wary of ambulating a pt. that I wasn't familiar with...even if you take all the precautions there's a chance they could fall and you could get yourself and your school in serious trouble.

Whenever I answer a call light I just check to see what the patient needs-if it's anything that requires them ambulating, I go find their CNA. I'll offer to help but I will not ambulate a patient myself unless I've personally seen their chart that same day. Sounds extreme but I've run into way too many situations where the CNA, the patient, even the nurse has given me incorrect our out-of-date information about a patients status and at the end of the day you have to CYA!

[amymina]

I am a second semester RN student and just completed a med/surg rotation. When we had down time, which wasn't often, we were to help answer call lights as well. Before ambulating with any patient, we were to find the CNA or RN that normally handled that patient to make sure there wasn't something we were supposed to know. That was our instructor's rule, and there were times the pts. wanted to get up, and we found out they weren't supposed to for one reason or another. So, if you aren't familar with a patient, I would check. Better safe than sorry.

[enchantmentdis, BSN, RN]

Hi:

You could ask a cna, another lpn, or an rn if a certain pt. can ambulate. Also it is okay to offer a bedpan; and if there is any question regarding ambulation, you could bring a bedside commode right up next to the bed. I believe every pt. should have a bedside commode at all times just in case.

Beware --even if two of you are getting a dementia pt. out of bed, even to the commode,-- because they naturally stiffen up and are a strain on the lumbar when they resist you. And because of their decreased cognition and fear they will usually keep resisting you even if you try to get them to relax by telling them you are here to help.

Always take care of your back, get one of those back supports on before you try to get anyone up or even if you turn them in the bed; use a gait belt, keep pt. physically close to your body, bend at the knees-not the waist; maintain good posture and body mechanics; and get help with large, confused, elderly, or stiff patients, and those that are recovering from surgery or are on telemetry. A lift team, if your facility has one, is an invaluable resource.

And if a pt falls, oh boy-there is tons of paperwork, you might have to get the pt x-rayed, you gotta call the family, you gotta call the md, and figure out and explain to everyone in the ward why the pt. fell, etc.. etc...Your nurse in charge might get ******, your school could get in trouble...yada yada. Good luck.

[~Mi Vida Loca~RN, ASN, RN]

We had white boards in rooms that were usually filled out as to how the patient ambulates. We also have red magnet circles outside their doors if they are a fall risk.

[ambertut]

If they are hitting their call light then they just did the assessment for you, they need help! It is much better for you to help ambulate a pt then to find out they did it on their own and ended up falling.

[~Mi Vida Loca~RN, ASN, RN]

If they are hitting their call light then they just did the assessment for you, they need help! It is much better for you to help ambulate a pt then to find out they did it on their own and ended up falling.

I am confused, how did they do the assessment for you??

If a person is a 2 person assist or large person that is very unsteady it would be important to know the ambulation status, the fact that they can hit the call button doesn't tell you that. I have found during clinicals, patients like to think they are far more independent then they are. They don't like having someone babysit for them and will play down their status if it's not unknown. This happened a few weeks ago, their was a patient that was a 2 person assist just got back from Gastric Bypass surgery. A student went to help her that wasn't assinged to her. Her board wasn't filled out. She told the student she only needed help getting in and out of bed, well patient passed out, knocked herself out on toilet and they ended up calling RRT and sending her up to ICU.

The op didn't suggest just ignoring the patient and not getting the right help. Sorry if I am misunderstanding your meaning.

[wifeandmomoftwo]

Thank you for all your replies. Looks like I'm not the only one who is uneasy about this after all. Grasshopper, thanks your last post. I certainly didn't mean to imply that ignoring the patient was an alternative solution.

[MattiesMama]

If they are hitting their call light then they just did the assessment for you, they need help! It is much better for you to help ambulate a pt then to find out they did it on their own and ended up falling.

I don't think anyone is suggesting the OP ignore the call light. There are just certain things you need to be cautious of...

case in point-just last week one of my classmates answered a call bell-the patient said she was thirsty. The student checked her dietary orders and saw nothing indicating she was on thicket or any restrictions, so she went ahead and gave her a glass of water. Come to find out, that same patient was scheduled for ECT that same day and was NPO-but because no one told her and nothing was posted about it, she had no idea. Thank god we caught it and let the staff know before the pt. left or she could have aspirated! They had to reschedule the treatment and it was a lot of paperwork and headaches and generally a big ole mess-over something as simple as a glass of water. I've just seen too many situations like that come up not to err on the side of caution.

[~Mi Vida Loca~RN, ASN, RN]

Thank you for all your replies. Looks like I'm not the only one who is uneasy about this after all. Grasshopper, thanks your last post. I certainly didn't mean to imply that ignoring the patient was an alternative solution.

I didn't get that impression at all and it looks like majority of the other posters didn't either, so no worried. I know when I did clinicals in the LTC facility this worried me even more and it seemed impossible to track people down to get answers!

[mybrowneyedgirl, BSN, RN]

I work on a Med/Surg floor and I always ask the nurse or look at their activity plan on their board or careplan to see if they have bathroom priviledge with assist. Some say they can get up when in fact they are confused or unable to get up due to medical, medication reasons.

[ttreeds]

I currently work in an acute inpatient rehab unit. If a patient calls to use the bathroom and i have never seen them ambulate before, or i'm not sure how they transfer out of the bed to a wheelchair, i call another nurse, or a cna to be right on the other side, ready to assist as needed. In your case you can grab a fellow nursing student to help you. You also want give basic instructions to the patient on what to do before they even get up to ambulate. It makes a huge difference when the patient has an idea what to do. You can never be too safe so always ask for assistance I hope this helped.